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By Quenton King, Mountain State Spotlight

Charleston resident Lakiesha Lloyd came out of her first stint in the US Army with several lingering problems. Nerve damage caused her to temporarily lose the use of her arm, and required specialized medical care and rehabilitation. She was ping-ponged among different doctors who disagreed about whether she had post-traumatic stress disorder. And she was left to navigate a complicated veterans health care system.

“But luckily, I was able to finally get a good doctor. I was able to luckily in the end, after 20 years of battling with all this stuff — mental and physical — I was able to get a hold of some good doctors,” she said. “That’s the unfortunate part. I’m the exception, I’m not the rule.”

Lloyd’s needs, including women’s health care and mental health care, are representative of the needs of a growing number of American veterans. In West Virginia and nationwide, the massive Veterans Affairs health care system is grappling with how to fulfill the promises the country made to care for former service members. But that’s growing more difficult as the overall veteran population shrinks and future veterans are projected to face very different challenges than they have in the past.

“The system was built for something that existed 80 years and just doesn’t exist [anymore],” said Todd Fredricks, a US Army veteran and professor of medicine at Ohio University.

That’s the rationale behind a recent government plan to streamline the entire VA health care system, closing hospitals and clinics across the country. In West Virginia, certain medical services like inpatient surgeries and VA emergency rooms are on the chopping block, which has drawn criticism from politicians, veterans and veterans’ advocates. But experts say the reality is that the VA will have to do something to alter its services for a geographically dispersed and smaller population, whether or not it’s the recommendations in the recent report.

the plan

With voluntary military service, the aging of World War II veterans, and smaller global conflicts, nationally the number of US veterans has shrunk in recent years. Even in West Virginia, a state that boasts a higher than average percentage of veterans than other states, the numbers are on the decline.

In 2018, there were approximately 144,000 veterans living in West Virginia. By 2048, the VA expects there to be only 80,000.

The veterans of the future will look a lot more like Lakiesha Lloyd, a Black woman, than those of the past. The VA projects that within the next 30 years, the number of women veterans in West Virginia will actually increase while male veterans decrease. And it expects to see a 61% increase in the number of non-white veterans in the state over the same time period.

All this means veterans will need certain types of care — including addiction treatment centers, elderly services, and more women’s reproductive health care. And the VA predicts there won’t be as much of a demand for services like inpatient surgeries.

“It really is a supply and demand issue, trying to balance where veterans live, how the VA can be in all places, all the time when veterans are displaced geographically,” said Carrie Farmer, co-director of the RAND Epstein Family Veterans Policy Research institutes. “And the needs of veterans are changing. It is a hard task. It’s this balancing act ensuring veterans can access care.”

This is a particular challenge in rural states like West Virginia. Rural veterans health facilities tend to see fewer patients than urban ones, especially when it comes to inpatient surgeries, according to the VA. That’s why part of the government’s proposal includes shuttering many underused emergency departments and inpatient surgeries at VA medical centers across the country. In West Virginia, three of the state’s four VAMCs — Beckley, Huntington and Clarksburg — would lose these services under the plan. And the plan also affects smaller outpatient VA posts in the state.

But Farmer says it doesn’t serve veterans’ health care needs to maintain these specialty services in places where they aren’t in high demand, either. That’s because the more often a doctor performs surgeries or treats patients, the better the outcome for their patients.

“If there’s a small hospital that’s not used very often, [quality of] care can decrease. Volume of care is related to quality of care,” she said.

Questions remain

While the VA has concluded it needs to change the overall veterans health care system, there’s still no final decision on what changes will be made where.The commission tasked with reviewing the recommendations has to give President Joe Biden a final report next year, and then he will make a decision on whether to submit it to Congress for final approval. And there are still lingering questions that remain.

Opponents of the VA recommendations point out the proposed changes will hurt veterans in rural areas who will have to drive further for care. They also note that according to a Government Accountability Office report, the VA didn’t take into account the quality of private care in a community or even whether providers would accept an influx of new patients. And those providers may not be able to handle the unique experiences of veterans and veteran culture.

“[Vets] are going to be forced into these regional medical centers across the state that weren’t designed for that,” said Ted Diaz, secretary of the West Virginia Department of Veterans Assistance. “One, they weren’t designed for that patient capacity. And two, they’re not trained in how to care for specific, wartime injuries, whether that be blast, bullet, fire, and the mental anguish that comes with that. They’re not trained for that.”

For Lakiesha Lloyd the VA is an institution that, for all of its flaws, is an integral part of reintegrating into civilian life and healing some of the chronic pain caused by years of military service.

She’s had visual reminders of that pain since she was a child. Her grandfather enlisted to serve in World War II, where he suffered a mortar blast and was whisked away to a military hospital that itself was attacked. He lived the rest of his life with pieces of shrapnel in his face that discolored his skin over time.

She says military service is part of her family’s DNA. In addition to her grandfather, her mother served, as did some of her uncles. Lloyd enlisted at 17, and she recently signed the forms to allow her own 17-year-old to start the enlistment process.

“When it comes down to it, we are a serving family,” Lloyd said.

Despite her problems accessing health care through the VA system in West Virginia, she’s skeptical the government’s proposed changes will benefit her. Though it took work, she’s found a way to get the help she needed through the current system.

After years of debilitating pain, a couple of years ago Lloyd got VA approval to get a neurostimulator implanted at the Marshall University neurosurgery department.

“And now I actually have quality of life again. I can actually get up and run around with my kids and have fun.”

Reach reporter Quenton King at quentonking@mountainstatespotlight.org.

The debate which has raged for the past two and a half weeks on the future of the National Maternity Hospital has (NMH), at times been frustrating but has more often been simply perverse.

The Government’s decision to pause the approval of the move from Holles Street to St Vincent’s Hospital was done to allow documents related to the deal to be published and for all the concerns held by people being fleshed out, amid some lingering concern among ministers.

Having watched every step of the debate, having read all that could be read on the matter, I was left baffled as to why and how the Government lost two TDs given the robustness of the guarantees of the deal.

As Kieran Mulvey the man who brokered the 2017 deal between the NMH and St Vincent’s made clear, all legal procedures will be performed in the new hospital.

As he said this week, the very clear statement made in the mediation agreement was that the laws of the state would apply in the new maternity hospital, and that all existing practices currently carried out in the NMH would be available in the new NMH.

“They were clear they were unequivocal in fact, there was little or no argument about that from either side once that paragraph was agreed,” he said.

Reaction of female politicians

After nine years of delaying this hospital project getting going, we were left in the curious position of some of the country’s leading female politicians claiming the process was being rushed and seeking to have it delayed even further.

It was bonkers.

It was if they have dug themselves into an ideological hole that they were unable to get out of.

Perhaps scarred by the legacy of the truly appalling treatment of women in our society over the last century, the levels of trust in the system are low

But the true scandal is not what is going to happen in the new NMH but what is actually happening in the existing maternity hospitals.

I speak from relatively recent experience of seeing my three kids born in the crumbling Rotunda Hospital where conditions can only be described as inhumane despite the best efforts of staff.

And we were lucky as all of ours were hail and hearty.

Many others are not so lucky and have had to face inordinate struggles to get the supports they need.

But to the hospital itself, even those who have proposed this deal will say it is complex and messier than they would have liked it to be.

Starting from scratch, as Taoiseach Micheal Martin said, you would not do it this way. You would ensure it was a publicly owned building on fully publicly owned land.

Both time and money wasted

But, the decision was made to co-locate to St Vincent’s Hospital and those behind St Vincent’s simply did not want to sell or gift the land to the State.

It was utterly frustrating to see so much time and energy wasted on this argument of why a 300-year lease at €10 a year was not sufficient.

Calls for the lands to be compulsorily purchased may sound snappy and good, but so slow is our planning system that such a move is not guaranteed of success and would further delay this project substantially.

And for what?

Even though there is a lease of 300 years, belt and braced alongside a constitution which makes it clear the church will have no influence, it is still not enough for some.

I am no fan of the Catholic Church. Like many of my generation, I have utterly renounced its teaching, dogma and despise the poisonous impact it has had on public policy in Irish life in the past century.

Also, as the Attorney General Paul Gallagher advised the Cabinet, the State’s interest is well protected here and there are layers of protection to ensure no religious ethos will be at play in the running of this hospital.

The constitution says so, not just once, but several times. As Dr Rhona Mahony explains, the greatest indication that all legally permissible services will be available in the new hospital is that they are already taking place in Holles Street, even with the Archbishop of Dublin as the chairman of the board.

The truth of the matter is; rather than continuing the direct influence of the church, again from reading the documents, it is clear such influence is ended. It will be a secular organization and institution

The six-month expulsion of two Government TDs for voting against the Government on a meaningless motion on the NMH in a way sums the utter lunacy of the past two and a half weeks.

The Green Party parliamentary party voted to suspend TDs Neasa Hourigan and Patrick Costello, who voted against the Government on a Sinn Fein motion concerning the new National Maternity Hospital

TDs Neasa Hourigan and Patrick Costello, no doubt convinced their stance is justified, felt compelled to go overboard because of the failure of the State to ensure the new hospital would be built on public land.

Expelled by their party automatically on Wednesday having voted for the Sinn Féin motion, Hourigan and Costello were always likely to fall foul of the rigid whip system as they have struggled to reconcile their ideology with the realities of compromise and coalition government.

Having voted against the Greens entering Government in 2020, it has always been a matter of “when” and not “if” they would break ranks once again.

But beyond their removal from the Government ranks technically (as they are likely to continue to support Government votes), it is fair to say many in the opposition who have been among the loudest voices of concern over the NMH have not covered themselves in glory.

Never-ending debate

The most alarming aspect of this whole saga has been that as soon as the Government and the backers of this deal satisfied the demand of a particular group or representatives on one issue, it moved on to another, becoming a never-ending cycle.

Like we had this rather incongruous situation that arts minister Catherine Martin was not OK with the deal until she got letters of comfort from the HSE, St Vincent’s and the NMH to state that certain procedures including abortions will take place in the new hospital.

Last week, for three hours at the Oireachtas Committee we had a debate going on between freehold and leasehold and which is better or worse.

Quite frankly, that’s not what the NMH is about.

It is and should be about the care of women who are giving birth so that they can be safe.

And if a difficulty occurs, they have available to them the specializations the discipline and the care they need quickly.

A large crowd of protesters carrying placards saying separate Church and State at a National Maternity Hospital protest rally outside the Dail (Leinster House).

From a relatively recent user of the system, I can tell you we were not interested in that kind of debate.

My only concern was that my wife and new babies would be safe and not at risk.

The Vatican has no more role in this now than any other foreign entity.

Albeit far too late, the Cabinet has now decided and approved the deal.

As opposed to selling out the women of Ireland, it was a good day for those who want to see the maternity services in this country advance beyond the cruel and intolerable state it is in

While of course we are shaped by our history, we should never allow ourselves to be imprisoned by our history and this saga has seen anger at what has gone before conflated into something else which in turn became a barrier to progress.

As cold as this may sound, this is not about what has gone before, but about ensuring better healthcare for the mums and babies of the future.

Let’s get on with it.

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After seeing and experiencing the lack of resources for women dealing with sexual health issues, Leslie Busick, the founder and CEO of Pique, took matters into her own hands. She started by curating virtual events during the pandemic where women would come together and discuss sexual concerns and topics. The conversations continued to gain traction and after partnering with close friends and Stanford graduate, Max Savage, they decided to create a digital health platform for women to receive personalized, sexual health care plans with tangible solutions to support their concerns. New patients begin their Pique journey with a complimentary introductory session with a nurse practitioner who specializes in sexual health and creates a custom care plan that may include different types of vaginal estrogen, sex & relationship counseling services, suggested lifestyle changes, and recommended resources from Pique’s library. Patients are able to track their progress with the Female Sexual Function Index (FSFI), a standardized sexual health quiz to measure sexual function in women. Busick hopes the brand will help to destigmatize the sexual health category and give women the power to take control of their health, pleasure and well-being.

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Pique’s clinical care team is led by Chief Medical Officer, Dr. Ashley Winters, a Weill Cornell trained board-certified urologist who specializes in sexual medicine. dr Winter and the team look at sexual well-being from a multi-faceted lens that integrates every aspect of one’s mental, physical, hormonal, and social well-being. “Pique is reimagining women’s health care at scale, spearheading a future where women can get the personalized, approachable, and effective care they need. I am thrilled to partner with Leslie to bring light to this underserved subject matter and use Pique’s platform to shift the narrative around women’s sexual health to reach and serve more women,” shared Dr. Winter.

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About Pique: Pique is an online sexual health platform starting with a focus on women in the menopause stage of life. The company delivers personalized care to help address concerns from painful sex, vaginal dryness and low libido, to helping women build confidence, maintain strong intimate relationships, overcome sexual trauma, and beyond. Patients are led through the platform by a nurse practitioner who specializes in sexual health and creates custom care plans that may include prescribing vaginal estrogen, sex & relationship counseling services, suggested lifestyle changes, and recommended resources from Pique’s library.

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Autumn Communications
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SOURCE Pique